Basic Information
| Provider Information | |||||||||
| NPI: | 1780873281 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STOJKOVIC JOHNSON | ||||||||
| FirstName: | MILI | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 255 W 94TH ST | ||||||||
| Address2: | APT. 20K | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100256999 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2125311623 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2109 BROADWAY | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100232106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127990160 | ||||||||
| FaxNumber: | 2127990209 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2007 | ||||||||
| LastUpdateDate: | 10/19/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 011590 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.